Methods:
EUREYE was conducted in seven European countries with ethics approval obtained at each centre. All participants gave written informed consent, were interviewed for risk factors, gave a blood sample and underwent digital fundus photography independently graded by the International Classification System into no AMD, large drusen, early and neovascular AMD. Dietary intake in the last year was assessed using a semi-quantitative food frequency questionnaire modified in each country to reflect specific country foods. We constructed a Mediterranean diet score (MDS) based on the consumption of cardio- protective elements in the Mediterranean diet such as olive oil, wine, fruits, vegetables, fish, legumes and whole-grain intake. We used linear regression to investigate the relationship between MDS score and blood antioxidants and logistic regression to investigate the association of quartiles of the MDS score with early and neovascular AMD (nvAMD), taking account of potential confounders.<br />

Results:
In those with no AMD, mean MDS was 4.87 (SD=1.33), ranging from 0 to 9 and was significantly associated with blood measures of vitamin C, lutein and zeaxanthin. The score varied by centre with higher scores in the Mediterranean centres compared to Northern European centres confirming the expected diet followed in those countries. The score was highest in Verona, Italy, 5.37 (SD=1.18) and lowest in Belfast, Northern Ireland, 4.42 (SD=1.30). In analyses adjusted for age, sex, country, education, smoking, drinking, cardiovascular disease and diabetes, increasing MDS was significantly associated with a decreasing risk of neovascular AMD, p trend=0.01; those in the highest MDS score quartile had a 50% reduction in the odds of nvAMD (OR 0.53, (95% CI 0.27 - 1.04)) or of large drusen (OR 0.80 (95% CI 0.65-0.99)).<br />

Conclusions:
In this cross-sectional study a Mediterranean diet appeared to be protective for neovascular AMD and large drusen. Prospective studies are required to confirm this association.